ACUTE RENAL FAILURE

LEARNING OBJECTIVES:

KNOWLEDGE - Students should be able to describe the:

1. pathophysiology of acute renal failure
2. metabolic consequences of significant reductions in renal function
3. indications for dialysis
4. management of the patient with renal failure

PATIENT CARE SKILLS:

1. History:   Students should be able to assess:

• baseline renal functional status
• family history of renal disease
• potential nephrotoxin exposure
• for co-morbid conditions which may cause renal disease

2. Physical exam:   Students should be able to evaluate:
   • volume status
   • effective arterial circulating volume
   • clinical signs and symptoms of uremia
     
3. Differential Diagnosis:   Students should be able to differentiate:

• acute vs chronic renal failure
• prerenal vs parenchymal vs post renal obstruction

4. Laboratory Findings:   Students should be able to interpret:

• urine lytes
• creatinine clearance
• spot urine protein: creatinine ratio
• urinalysis
• renal ultrasound
• renal biopsy

5. Communication Skills:   Students should be able to:

• provide patient education
• discuss end of life issues
• take into consideration each patient's psychosocial status
• develop effective doctor-patient communication skills

6. Procedure Skills:    Students should become proficient at:

• IV placement
• arterial blood gas
• Foley placement

7. Management Skills: - Students should be able to manage:

• drug dosing adjustments
• renal dietary restriction
• volume states
• electrolyte imbalance
• acid-base disturbances
• intoxications

 

ATTITUDES AND PROFESSIONAL BEHAVIORS :

1. Demonstrate respect for the patient.
2. Attend to and advocate for the patient's interests and needs in a manner appropriate to the student's role.
3. Recognize the importance of allowing terminally ill patients to die with comfort and dignity.

REFERENCES:

1. Albright, R.   Acute Renal Failure:   A Practical Update.   Mayo Clniic Proceedings.   Vol 76(1).   Jan 2001.   pp67-74